ASTHMA IN

PREGNANCY
DR.R.SOWJANYA

INTRODUCTION
Asthma is a chronic
inflammatory airway
syndrome.
Seen frequently in young
women and therefore
often complicates
pregnancy.
The estimated asthma
prevalence during
pregnancy ranges between
4 and 8 percent, and this
appears to be increasing

Physiological
alterations in pregnancy
Vital capacity and inspiratory capacity
Tidal volume, Minute ventilation
Residual volume, Chest wall compliance,
Expiratory reserve volume, functional
residual capacity
The end result of these pregnancy-induced
changes is substantively increased
ventilation due to deeper breathing

Pathophysiology
The hallmarks of asthma are

reversible airway obstruction from

bronchial smooth muscle contraction
vascular congestion,
tenacious mucus, and mucosal edema

IgE also plays a central role in

pathophysiology

Clinical course
Hypoxia initially is well
augmented by hyperventilation,
which maintains arterial Po2
-results in respiratory alkalosis

Airway narrowing worsens,

ventilation perfusion defects
increase
-arterial hypoxemia sets in

CO2 retention
-respiratory failure follows

Effect of pregnancy on
asthma
The symptoms may worsen, improve
or remain stable during pregnancy.
Risk is higher following caesarean
versus vaginal delivery.
Exacerbations are associated with
respiratory infections and poor
compliance with inhaled steroids.

Effect of asthma on
pregnancy
Unless disease is severe, pregnancy outcomes are
generally good.
Incidence of abortion is slightly increased
Higher risk of preeclampsia, preterm labour,
IUGR, perinatal mortality. Good control reduces
this risk.
Life threatening complications of severe asthma
include respiratory arrest, pneumothorax,
pneumo-mediastinum, acute cor-pulmonale and
cardiac arrhythmias.

Clinical features
Symptoms are similar as nonpregnant
and include cough, dyspnea and
wheezing on auscultation.
Varied manifestations of asthma
have led to a simple classification
that considers severity as well as
onset and duration
of symptom

Clinical evaluation
Pulmonary function testing should be
routine in the management of chronic
and acute asthma.
FEV1 and PEFR are the best
measures of severity.
ABG is required in acute severe
attack.

Management of chronic
asthma
Patient education
Avoiding environmental precipitating
factors
Objective assessment of PFTs
Monitoring of PFTs
Pharmacological therapy with compliance
Treatment depends on disease severity.
Beta agonists and inhaled steroids are safe
in pregnancy.

Management of acute
asthma
Hospitalization
Oxygen by mask
Pulse oximetry
Beta adrenergic agonists- oral/SC/inhaled
Corticosteroids- oral/IV- IV methylpredsinolone
40-60mg every 6 hours or equipotent doses of
hydrocortisone
Further management depends on response to
therapy with close observation and FEV1,PEFR.

Status asthmaticus
Severe asthma of any type not
responding after 30-60 minutes of
intensive therapy is termed status
asthmaticus.
Rx- admission to ICU

Beta agonists
IV corticosteroids
Intubation and mechanical ventilation.

Intrapartum management
Asthma may worsen through delivery.
Stress dose corticosteroids are
administered to any woman given
systemic corticosteroid therapy
within the preceeding 4 weeks. Usual
dose is 100mg of hydrocortison given
intravenously every 8 hours during
labor and for 24 hours after
delivery.

 Oxytocin and prostaglandins E1 and

E2 may used
Prostaglandin F2 or ergotamine
derivatives are contraindicated.
Regional analgesia is preferred
because tracheal intubation can
trigger severe bronchospasm.
Fentanyl is preferred to morphine.

Postpartum and
breastfeeding
Continue the same asthma
medications
Close peak flow monitoring
Compliance reinforced
Breastfeeding encouraged

THANK YOU..